Why Normal Female Anatomy is "Outside the Range of Normal"

Warning: This particular note is more uncomfortable than usual.

Disclaimer: Yes, I am generalizing here!

I heard a nurse complaining a few weeks back that in most anatomy books, the generic anatomy form is that of a man's. I don't have a problem with that (and I don't have an anatomy book to confirm that claim). I'm not suggesting that it should be a woman's form, but as I was thinking about that complaint, something clicked. Yes, we all know that men run the world. Whatever. Women raise the men who run the world, so that in itself doesn't bother me. What bothers me is the realization in the medical world—which has been largely pioneered by men—any anatomy which differs from a man's is abnormal. And anything abnormal needs to be corrected.

Now, they may not be thinking that consciously, but just take a look at the evidence. Birth is a physiological event. It is no more medical than peeing (granted, it's a lot harder). It is something that the female body is built for. Perfectly. Yes, there is a range of differences between bodies, and some (very few, hardly any) are outside the range of normal and may require extra assistance or accommodations. And yet, in the hospital setting, which is ruled and controlled by men even if all the doctors and nurses are women (because their medical education is led by men), there isn't a single person who trusts a woman's body to give birth.

Not. One.

Don't believe me? Think you're a doctor or nurse who does?

Then don't touch her.

Seriously. Try it. Even just try to imagine what that would be like. Don't touch her. Don't poke her. Don't prod her. Don't even talk to her. Put her in a comfortable room, and let her be. Are you doing it? Is is hard? Is it even possible? I'm thinking for a doctor or nurse, no it's not possible. Because you believe that the body isn't designed to give birth, because MENS bodies aren't designed to give birth.

Point number two: the world doesn't value women for their intelligence or even their inherent ability to nurture. I know a lot has changed since the '50s, some for the better, some for the worse, but this is just as true today as it has ever been. Again, just look at the evidence. Women know that their bodily functions are normal, even if they are outside the range of normal for a man, and yet thousands of women go through medical school and don't correct the medical misconceptions stated above. This may be speculation at this point, but perhaps those women doctors and nurses do attempt to correct the misconception, and they are ignored. Either that or they are so terrified of not being accepted by their male peers that they aren't comfortable with correcting what they know to be wrong. Or, they don't believe that they know as much about the female body as men do, so they accept what they are taught as truth (I'm betting on this last one). They may be accepted into the medical world as peers, but not as pioneers.

Then take a look at the ongoing controversy about breastfeeding in public. The arguments are silly. Those against it claim they don't want to see womens' breasts hanging out wherever they go. And yet the people they ask to cover up rarely have anything showing at all. When I nurse—without a cover—my shirt is pulled all the way down to my baby's mouth, but doesn't cover the baby's face at all. Sometimes, I have to show a little skin on my side, but it's far less skin than a teenager shows when she's sports a shirt that shows off her midriff, not to mention a bikini.

Besides that, let's be honest. Women have to leave their homes sometimes. Yeah, really. And if they leave their homes, they still have to feed their children. Eating in the bathroom is disgusting for anyone. Most of the suggestions given by anti-NIPers are simply impractical. But the question that always gets me is why? Why are they so uncomfortable seeing a woman breastfeeding in public, even when nothing is showing. Because women aren't valued for nurturing their children.

The underlying reason people are uncomfortable seeing women breastfeed in public is because even today, women are only valued for one thing: sex.

Men see a woman nursing in public and they don't think about how that woman is providing nourishment for a child. They think about how if they were in the position of the infant or toddler, that breastfeeding would be a sexual act.

Okay, now everyone is uncomfortable.

See what I mean? Performing a sexual act in public is highly disturbing to everyone involved. And because men don't understand that the female body is not the same as a man's body, and functions in a very different way while still being withing the realm of normal, they can't see breastfeeding as anything other than a sexual act.

It's. Not.

So let's go back to maternity wards. How prevalent is this belief that women are only good for sex? How about we bring up the many obstetricians who have recommended cesareans to women in order to preserve their “lady parts.” After all, we wouldn't want to let a baby “mess up anything down there.” Or how about the OB who is stitching up an episiotomy which he just cut, and he stitches up her vagina slightly and then turns to her husband and says, “you'll thank me for this later.”

No, I'm not making this stuff up. Yes, this stuff happens more often then most people like to think.

But let's continue. What about vaginal exams? They're designed to tell us how dilated a woman's cervix is, correct? The argument is that they use that information to predict when a woman in labor will begin the second stage of labor. Is it accurate? Not remotely. Some woman can be dilated 6 cm for weeks. Other women will go from 1 to 10 cm in an hour. Some women begin pushing at 5 cm. Other don't push for hours once they've reached 10. Yes, these are all the extremes on the spectrum, but you know what? Just because they are extremes doesn't mean they are uncommon. The point being that routinely gathering information about cervix dilation is pointless.

So how did it come about? I can bet that midwives (women) didn't start it, though many unfortunately practice it routinely today—also a case of not valuing women for their intelligence (if they did, they would continue to practice the way women practiced successfully for 1000s of years). Male doctors started it. I believe that the doctors, nurses, and midwives who practice it today do have good intentions—most of them anyway. Still, some of them probably enjoy putting their hands where they are not welcome a little too much.

Consent isn't consent if it is requested by an authority figure claiming it is a medical procedure when it is not. Routine vaginal exams in labor have no medical value. So what motive does that leave us with? I don't think I have to say it.

It's especially obvious when I listen to stories from women describing how they would scream at a doctor or nurse to stop, to not touch them, to remove their hand, or simply shout “no” and that nurse or doctor continues regardless.

What's the point of all this? Society still only places sexual value on women, not intellectual or nurturing value. Even some feminists (the ones that give the rest of us a bad name) believe that they only way they can be valued in society is if they act and dress like men. But above all, doctors don't believe women can give birth, so don't go to a doctor if that's what you want to do.

Bravery has nothing to do with it.

Whenever I tell people I had a home birth, their first response is always (unless they've had one themselves) "Wow, you're brave."

Bull. Crap.

Before I made the decision to stay home, I did a ton of research, but all of that was only to validate the possibility. The truth is I'm mortified of hospital birth. Utterly, stone cold terrified.

There are two reasons for that. The first is, to most doctors and hospitals, I'm a walking surgery waiting to happen. Even though the American College of Obstetricians and Gynecologists (ACOG) publicly supports trial of labor (TOL) for most vaginal birth after two cesareans (VBA2C), the liability involved in "allowing" women to "attempt" VBAC in a hospital is ridiculous and dangerous to everyone involved (as a laboring woman, you can never be sure if the doctor REALLY means it's legitimately time for a cesarean, or if he's just trying to escape liability).

My two cesareans were largely routine. The first happened after nearly a full day laboring in the hospital (6-something AM to nearly 10 PM). A nurse had to push DS1 back into the uterus while the head surgeon pulled him out from the incision. The incision tore slightly during his extraction, but didn't do any serious damage. I bled a little, but not enough to be a worry. Nothing to see here. My second was even less interesting. No labor. This one was scheduled. The poor doctor had to hack through a lot of scar tissue, so it took a while to make a proper opening, but DS2 came out easy. He was a bit skinny, but required no extra help or NICU time (thank heaven!). I did a little bleeding here too. It wasn't much--my doctor called it "weeping"--but my doctor finally gave up on stopping it because it was so little and sewed me back up again. The end. No infections. No separation. No hemorrhage. Nothing.

Physically.

Well, that depends on how you define "physically."

First off, whoever claimed the second cesarean is easier, especially if there is no labor, has never had a freaking cesarean! It's the biggest line of BS doctors feed women these days, and that's REALLY saying something! Surgery sucks, okay? You shouldn't have to do it unless you have to do it.

The second reason is this: The circumstances surrounding that second delivery were not pleasant. I know I've shared the story before, so I'll keep it short. I had the VBAC rug pulled out from under me mere weeks before I was due. I had no chance to make other arrangements, so my choices were effectively give birth in the woods, or let them eviscerate me again. Under the circumstances (aka: duress), I chose repeat evisceration.

I later (much later) learned the name for what I suffered after that: birth related post traumatic stress disorder (PTSD). It's not an easy to describe condition. You know that feeling you get when you come dangerously close to a particularly large and nasty-looking arachnid? When your heart jumps into your throat and your muscles seize up, and you can't sleep for hours afterward? Yeah, fight or flight. PTSD feels like that.

All. The. Time.

I'm not writing this to complain. After my most recent birth experience, the symptoms are greatly diminished, though it'll likely never go away completely. Those kinds of brain changes are sort of permanent. But I digress. The truth is I think I can honestly say that I would rather die than go through the early stages of PTSD again. No really. It's that awful. And while I still have ups and downs, just like everyone else in the world (though mine are a little different, usually consisting of terrifyingly realistic waking nightmares of SWAT teams extracting me from a locked fortress so they can drag me off and cut me open again), I would never risk the progress I've made in PTSD recovery. Ever.

So even not even addressing the numerous articles and research papers saying that home birth is as safe as hospital birth, if not more so under the right circumstances (and if anyone mentions the seriously flawed and debunked Wax meta-analysis, I'll kick them in the teeth repeatedly), along with the research showing that VBAC is safer than repeat cesarean for both mother AND baby (yes, the line that repeat cesarean is safer for baby was shown to be false in April of 2010), I had a VERY good reason to stay away from the hospital in labor.

And it had nothing to do with bravery.

Next Time You See A Mother With A Newborh, Ask Her How She's Doing.

A few weeks after I gave birth to my 3rd little boy, I met a new mother in church who brought her two-week old with her. She ended up leaving early, but not before I had a chance to speak with her. I hadn't seen this woman since she announced her pregnancy, and I was worried about her for multiple reasons. She normally sits behind my family and entertains my children during the meeting. We've never been close, but I enjoy talking with her when I have the opportunity. I consider her a friend.

When she told me she was pregnant, we talked about birth options briefly. It was only brief because I could tell very early on that she was not open to the options outside the mainstream. The choices she wanted I could tell would most likely lead to a cesarean section. I politely mentioned this point and brought up a few risks she may not have been aware of, praying that she would at least consider forgoing some of the more invasive drugs. She brushed it off...exactly the same way I did with my first pregnancy.

When she returned with a baby, before I was able to approach her, I noticed many others coming and going, all fawning over her beautiful little baby. I couldn't exactly blame them. There's something about tiny humans that pumps the rest of us full of oxytocin. But not one of them asked about the mother. Sure, they all spoke to her, soliciting details about the baby's birth weight and age, etc. But not one asked her how she was doing.

That's an easy way to make a messed up woman who desperately needs support after giving birth feel even more like crap. It's the same message: “you're baby is healthy, so how you feel doesn't matter.” Even if that isn't the intention, that's how it'll be interpreted by the person who needs help, but doesn't know how to ask for it.

I'm not claiming to be a saint or anything, but I regrettably have some experience in this area, so when I came to her, I didn't ask about her baby. I didn't tickle his cheek. I didn't comment on his outfit. There were plenty of others who could fill that role. I right away asked her how she was doing, if she was recovering well.

Turns out she wasn't. Not at all. As I predicted—and I'm not happy at all about being right on this one—she had an “emergency” cesarean. Failure to progress. “Emergency” my eye!

Her incision site was infected and she was in constant agony. But true to form, and just like every other woman I've met in her situation, she hid it behind a fake smile.

No one asked

So she never told.

Instead she pretended to be happy, because that's how everyone expected her to be. After all, no one died. What did she have to complain about? Her baby was healthy. It doesn't matter that she wasn't—that getting out of bed was excruciating, or that she was privately on the verge of tears from the constant pain.

I passed on what recovery information I knew off hand, and then directed her to the ICAN website for more help. I just find it amazing that if I hadn't asked, no one would've had any idea.

So if you have a baby and I ask about your well-being before congratulating you on your healthy baby, it's not because your baby isn't beautiful, and it's not because I'm seeking an I-told-you-so moment for a mainstream hospital birth gone bad. It's because I care about YOU.

That hasn't changed just because you had a healthy baby.

Why You Feel Guilty

I know I make a lot of people uncomfortable with my strong opinions. When reading articles I post and the attached mini-rants, keep in mind one thing: I'm speaking of the rule, not the exception. Obviously there are situations in which nearly every procedure I rail against is necessary. They wouldn't exist if someone somewhere didn't think they helped something sometimes. I'm not ranting against their use under the right circumstances. But I don't believe treating a healthy person like a sick person will prevent the healthy person from becoming ill. In fact, I have seen with my own eyes how doing so can cause medical complications which otherwise would not have existed in the previously healthy individual. I've also studied the research, and it continues to support my observations.

I have been informed a number of times over the past two years that I make women feel guilty for their birth choices. My stock “feel-good” response to that is if you believe you made the right decision, you probably did. Sometimes that's exactly right. Most of the time, however, it is not.

If you want to continue to accept the “feel-good” version, and don't want to hear something that might be difficult, or force you to strongly consider making different choices in the future, stop reading now.

No, seriously. Stop reading.

Don't continue out of curiosity. If previous posts have made you uncomfortable, this is going to be down right offensive.

That's right. Click the little “x” in the top corner of your screen. I do still want to have friends after this.

Alright? Is everyone left ready to hear a truth that may be life-changing? Good, then read on, brave souls!

If my expressed strong opinions make you feel guilty, you probably did make a wrong choice. You're feeling guilty for a reason: You. Chose. Wrong.

But just because you chose wrong, doesn't mean it's your fault, and just because you chose wrong once/twice/many times doesn't mean you have to choose wrong again. Remember, unfortunately sometimes the best of all available choices is still a wrong choice.

First off, medical care providers should be trustworthy. Saving lives, easing pain, healing the sick, comforting the belabored are all parts of a very honorable trade. Our culture depicts these men and women in the light their work deserves. And most of them are good and honorable. Nearly all of them are also subject to the limits of their training, licenses, insurance companies, lawyers, and legislatures, but I'll get to that in a minute.

First, I want to address the existence of douche-bag care providers. Yes they exist. This does not represent most of the profession, but it does represent a chunk that is too large. Unknowingly, sometimes we put our care in the hands of one of these douche-bags. Sometimes we see red flags in the course of our care and either ignore them, or think we're too far into our care to change, but not always (FYI, it's never too late to fire a doctor or midwife). Sometimes their sliminess doesn't appear until the damage is already being done, and their hands are where they don't belong doing what they shouldn't be doing, or we're abandoned and alone when we need support most, or we're giving misleading information at a critical decision-making moment, or any number of other damaging and unforgivable acts.

If this happened to you, you made a seriously wrong choice, but you know what? IT WAS NOT YOU'RE FAULT!!! You didn't know he or she was a jerk, or if you caught a whiff of dirty hands, you innocently trusted them anyway, because doctors and midwives are supposed to be good people. Trusting people who should be trustworthy can sometimes be a wrong decision, but it's never your fault when those people you trusted fail to live up to your good expectations.

As for the non-douche-bag care providers who won't give us care in the way we need/want it, I could write a book about their motivations for doing so. Suffice it to say, these are good men and women who want to help as many people as they can. Sometimes that means they have to bend to unreasonable laws or regulations in a way that is not in everyone's best interest. To some of their patients, it can be incredibly damaging both physically and emotionally, but it keeps them in a position to help others. If you could help 1,000 people, but only if you seriously harmed one, would you? It's a difficult choice, and I don't envy those who have to make it. This is one reason why I harbor no ill-will towards the doctors who are directly responsible for my two-year journey through hell. In a way, they were victims too.

Also in that category are the care providers who are limited by their education. I read somewhere (I think it was a guest-post on The Unnecesarean, but I'm not positive) about an OB reflecting on one of the first medical school experiences he had. One of his professors got up and told them that fifty percent of what he would learn in medical school was wrong, but they wouldn't know which fifty percent was right. When I reflect on my first labor experience (and after reading a very detailed version of my medical records from that time), I can plainly see that my obstetrician tried absolutely everything he knew how to do to avoid the cesarean he eventually had to give me anyway. Knowing what I know now, I can see things he didn't try that probably would have worked (though I'll never know), and I see things I could have done before I ever went into labor that may have prevented the whole scenario entirely, but they weren't techniques he would have encountered in his training as an obstetric surgeon. I can't hold him responsible for information he never would have received.

In these cases of good and well-meaning providers who still harm us, or can't or won't help us, we still made a wrong decision, but again, it wasn't our fault. These people were as trustworthy as we should expect them to be, but their hands are tied in one way or another.

So, you feel guilty when you encounter my strong opinions? You probably made a wrong choice. Are you willing to accept that? I can understand if you're not, but don't be angry with me. I'm just the messenger.

And I won't stop shouting my message. I may me a tiny voice with a miniscule audience, but I can't go back to pretending that the women I speak for don't exist. They feel alone enough as it is. Nobody understands what they're going through, unless they've experienced it for themselves. I speak out because I don't want you to end up like one of us. I want you to learn to make the right choice the easy way. I would hate for you to have to traverse the path that brought me here. The very thought brings me to tears.

I understand that to accept that a care provider might have done something to you that was not in your best interest is an earth shaking idea. This is someone you trust that we're talking about. They may even be a friend. As explained above, I'm not suggesting they're bad people, or even bad doctors! But they have to make hard choices, and sometimes those choices may not be in your favor.

It reminds me of an episode in the 5th season of Angel (spoilers!), where Fred is infected with the consciousness of Illerya, a long-dead god. Angel dashes off to find a way to free his friend from the infection that will surely kill her (yes, Fred is a girl, for those of you who aren't familiar with Angel). He finds it, and learns that the only way to save Fred's life is to do something which will kill a large portion of the planet's population. And so he let's his friend die a horrible and agonizing death.

If you've been reading my posts, I don't have to mention the specific things that should simply not be done to pregnant women, or women in labor, or women postpartum. If you've given birth or “delivered” in a hospital, you've had several of those things done to you. There's no “maybe” or “most likely” about it. They have been done to you.

And I'm very sorry.

No one should be treated that way. You deserve better.

Do you believe me?

If you do, that is your call to action. You do deserve better, but I can't just give that to you, as much as I wish I could (and I will do everything in my power to help). Your right choices may also be different from my right choices.

In Ayn Rand's Atlas Shrugged, one of the answers to the oft repeated question “Who is John Galt?” is that he was a great explorer who went looking for the fountain of youth:

“'John Galt spent years looking for it. He crossed oceans, and he crossed deserts, and he went down into forgotten mines, miles under the earth. But he found it on the top of a mountain. It took him ten years to climb that mountain. It broke every bone in his body, it tore the skin off his hands, it made him lose his home, his name, his love. But he climbed it. He found the fountain of youth, which he wanted to bring down to men. Only he never came back.'

'Why didn't he?'...

'Because he found that it couldn't be brought down.'”

Even when I didn't know anything, I knew SOMETHING!

My birth story with my first son sounds like it should have been traumatic: around 24 hours of labor, 5.5 hours of pushing, posterior baby (epidural was insufficient to block out the resulting back pain), failed vacuum extraction, ending in cesarean. To be honest, it really wasn't. I want to kick myself for how stupid I was back then, and how I so blindly trusted people who know nothing about the birth process at all, but that's another story.

I didn't know anything about birth either. I'd read What to Expect When You're Expecting, but that's all. I didn't even attend the hospital's How to be a Good Patient class. I'm not going to blame myself for that lack of education either. I was taught I could trust my doctor to tell me any pertinent information. That's what our culture believes right now. I won't fault anyone for trusting someone too much.

But even though I didn't know anything, there were some things that even then felt absolutely WRONG! After everything was over and I was recovering well from surgery, I was mad! Here's why:

I was freaking STARVING! They only let me have flavored ice chips the whole time I was laboring there (about 16 hours), and before that all I'd eaten was a single pudding cup since dinner the day before. Then when they announced I would have surgery (notice I said "announced" not "recommended" or "asked"), they wouldn't even let me have water! So I went about 36 hours without any food (minus the pudding cup). In the morning I was hoping for a decent meal, and what to they bring me? Chicken broth! That's ALL! What the crap! I felt like I had just run a marathon and then been hit by a truck at the finish line. The least they could have done is bring me a stupid bowl of Corn Flakes. It was another full 24 hours before they let me eat anything more solid than jello. I think my mom may have sneaked me a granola bar somewhere in there, but my point still stands. Why exactly are we starving women in maternity wards?

I know the whole "just in case" anesthesia argument, and frankly, I think it's totally invalid. Sure, if someone KNOWS they're going to have surgery, tell them not to eat or drink. That's fine. But I'm willing to bet that at least some of the time, laboring women are given surgery for reasons directly related to not having eaten or drunk anything in labor. Rather than give a blanket denial of nutrients to someone doing something physically taxing, instead provide a list of the top ten worst foods to eat in case of impatient doct--oh, I mean surgery. I understand peanuts are especially bad, for instance.

The other thing that bothered me was sleep. I got about 3 hours of sleep in early labor, then I couldn't anymore. When I went to the hospital and got an epidural, I managed to catch a little bit of sleep here and there, but nothing really to speak of. So after surgery, I figured I'd finally have a chance to sleep. I took advantage of the nursery for this reason. But for some reason, the nurses felt the need to wake me up every 15 minutes THE ENTIRE NIGHT! I was even more pissed about that than my measly broth breakfast. Is that REALLY necessary? Really? Really?! I'm hooked up to monitors, so they knew I wasn't dead.

Conclusion? Even people having babies need to eat and sleep. I knew that even when I knew absolutely nothing about birth. So why didn't the hospital staff get it?

How to recognize if a friend has experienced birth trauma

There are in no particular order. Every woman reacts differently, so good luck.

External signs that a woman has experienced birth trauma:

(Note: Some of these signs show up immediately, but many won't manifest themselves for several months)

• She may isolate herself

• She probably cries often

• She doesn't smile much

  • Or she may feel guilty for being sad at a time when society says she should be happy, and smile for everyone else's benefit

• She doesn't notice her baby growing up

  • She might often dress her baby in clothes or diapers that are too small

  • She might swaddle her baby tightly long after the first three months, when swaddling begins to be less effective

• Her memory may be worse than usual

• She may get angry easily

• She may be very anxious or fearful

  • Especially near the site of her trauma

  • Or especially when you discuss birth stories

• She may be obsessed with the topic of birth

• She may feel the need to tell her story over and over again

  • She's trying to process what happened in her own mind

• She may appear catatonic at times

  • She's not catatonic, her mind just isn't in that place or time

  • She's usually reliving her birth experience

• She may suddenly look very afraid or sad

  • She may be having flashbacks

• She may mention having flashbacks or nightmares

• She may ignore the cries of her children

• She may be unable to ignore the cries of her children

• She may become very debilitatingly anxious at the cries of her children

  • She may then either freeze up

  • Or explode

Whether or not a woman experiences birth trauma is not dependent on her giving birth in a way that appears traumatic to others, however there are some birth experiences that women are more likely to find traumatic than others. She's more likely to feel her birth experience was traumatic if:

• Her baby spends any amount of time in the NICU

• She has an emergency cesarean

• She has a non-emergency cesarean after a long labor

• She has a very long labor

• She has severe tearing during a vaginal birth

• She transfers to a hospital after an attempted home birth or birth center birth

• Her baby experiences shoulder dystocia (shoulders get stuck upon exit)

• Her baby required resuscitation

• She attempted VBAC and still had a cesarean

• She had an emergency hysterectomy

• Her baby died at birth, or shortly thereafter

  • Keep in mind that her birth experience is still separate than the outcome. She will need to grieve each part separately.

ATTENTION ALL BIRTH ATTENDANTS!

For anyone out there who is a birth attendant of any kind: please, please, PLEASE! It doesn't matter if you do everything absolutely perfect, but don't EVER take a mother's choice away. It is SO damaging when you do. Don't just follow your routine and go through the motions. ASK FIRST. And if she says 'no', DON'T pressure her. It's HER choice, not yours. And if you take it from her, she will remember it for years, and suffer like you would never believe. Her permission is all she has left to give. Don't betray her trust.

Sorry, been to the Solace for Mothers forum, and I'm always appalled at the kind of treatment women get while they're in labor. Just because you've seen a few (or even thousands) births, doesn't make you an expert on THIS birth. Only the mother can be that. Trust her.

/rant